Coaching Intake Form

Name*

Email*

The purpose of the coaching intake form is to assess your strengths, weaknesses, and coaching goals. Coaching is always tailored around your agenda, so as your goals change, let me know and we can revisit these questions.

List your TOP 5 STRENGTHS:

Think about what you are naturally good at, perhaps what people compliment you on.

List your TOP 5 AREAS YOU WANT TO IMPROVE:

Think about the personal weaknesses or skills you wish to develop.

List Your TOP 5 JOB-RELATED SKILLS or AREAS OF KNOWLEDGE:

List the 5 PERSONAL ACCOMPLISHMENTS of which you are most proud:

List 5 THINGS THAT YOU ARE PUTTING UP WITH:

Draining things that you don't really want or need in your life? (Smaller ones might be the piles of paper/clutter in your home office that bug you, the suit you've been meaning to take to the tailor, etc; Bigger ones might be a draining relationship, difficult boss, or feeling stuck about your career.)

Describe what personal and professional changes you would like to see happen as a result of our coaching?

List 3 Short-Term Goals (in the next month):

List 3 Long-Term Goals (in the 3 next month):

What may be another longer-term goal for 6 months from now?

Describe where would you like to see yourself 1 year from now?

How will it feel to be there and accomplish all of these goals?

What concerns do you have, or potential barriers to meeting these pre-established goals?

(such as fear of failure/success, time constraints due to a job, skill-deficits, etc.) List as many as you think of:

Specifically, what changes do you think would need to occur for you to overcome these obstacles?

(such as prioritizing regularly, time management systems, delegating)

What is the best way to ensure that you are successful?

(such as breaking goals down into more manageable steps, establishing rewards).

How tough do you want your coach to be? In other words, what coaching style do you think will work best for you?

(Example: directive, to the point, and tough on deadlines; or more nurturing, gentle, just allowing you to move at your own pace-and remaining supportive?). How would you like to handle accountability? For example, completing fieldwork assignments, or when you aren’t taking the necessary steps to meet your pre-established goals?

Anything else you want me to know that will help us with our coaching?